Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation

Helen Elizabeth Denise Burchett (), Sally Griffin, Málica de Melo, Joelma Joaquim Picardo, Dylan Kneale and Rebecca S. French
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Helen Elizabeth Denise Burchett: Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
Sally Griffin: International Center for Reproductive Health, Maputo 1100, Mozambique
Málica de Melo: International Center for Reproductive Health, Maputo 1100, Mozambique
Joelma Joaquim Picardo: International Center for Reproductive Health, Maputo 1100, Mozambique
Dylan Kneale: EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
Rebecca S. French: Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK

IJERPH, 2022, vol. 19, issue 21, 1-29

Abstract: Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or ‘upstream’ determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were ‘likely effective’ or ‘likely ineffective’ due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents’ life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.

Keywords: contraception; family planning; adolescent; structural; upstream; intervention evaluation; cash transfer; schooling; norms; empowerment (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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